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The following is a summary of “Effect of Screening for Undiagnosed Atrial Fibrillation on Stroke Prevention,” published in the November 2024 issue of Cardiology by Lopes et al.    

Atrial fibrillation (AF) often remains undiagnosed and independently raises the risk of ischemic stroke, which can largely be prevented by oral anticoagulation.  

Researchers conducted a prospective study evaluating older adults screening for undiagnosed atrial AF using a 14-day electrocardiographic (ECG) monitor to reduce stroke.  

They conducted the GUARD-AF trial to determine whether screening for AF in people aged 70 and older using a 14-day single-lead ECG patch monitor could identify undiagnosed AF and reduce stroke risk. Participants were randomized 1:1 to screening or usual care. Primary outcomes were hospitalization due to stroke (all causes) and bleeding; an intention-to-treat analysis was also performed. 

The result showed 11,905 participants in the trial (intention-to-treat population), with a median follow-up of 15.3 months (Q1-Q3: 13.8-17.6 months). The median age was 75 years (Q1-Q3: 72-79 years), and 56.6% were female. The risk of stroke in the screening group was 0.7% compared to 0.6% in the usual care group (HR: 1.10; 95% CI: 0.69-1.75). The risk of bleeding was 1.0% in the screening group and 1.1% in the usual care group (HR: 0.87; 95% CI: 0.60-1.26). The AF was diagnosed in 5% of the screening group and 3.3% of the usual care group. Oral anticoagulation was started in 4.2% of the screening group and 2.8% of the usual care group. 

They concluded that screening for undiagnosed AF using a 14-day ECG monitor in older adults did not reduce stroke hospitalizations.  

Source: jacc.org/doi/10.1016/j.jacc.2024.08.019